In Kyrgyzstan, Heroin Treatment Programs Show Promise

A dramatic rise in drug addition in Kyrgyzstan, and across Central Asia, accompanied the collapse of the Soviet Union in 1991. The largest share of addicts in Kyrgyzstan is found in southern regions, near major drug trafficking routes out of Afghanistan. For example, according to unofficial data, roughly 10,000 drug users live in Osh oblast, and 70 percent of these are intravenous drug users.

The addiction issue has also raised concern about the spread of HIV/AIDS. There are only about 300 registered HIV sufferers in Kyrgyzstan, according to official statistics, but UN experts estimate the actual number may be 10 times that number. Many of those who are HIV positive are intravenous drug users.

In an attempt to contain the threat posed by drug addiction officials authorized a methadone-replacement therapy (MRT) program in Osh and Bishkek in 2002. The program's initial success helped secure new funding from the United Nations in February. It now may serve as a model for similar programs in Belarus, Georgia and Ukraine. Kyrgyzstan became the only former Soviet republic to administer methadone treatments out of desperation, according Mamasobir Burhanov, the head of Osh oblast's main dispensary.

"Our city is the hub for drug traffic from Afghanistan," he says. As overwhelmingly poor residents lacked information about how intravenous drug use could lead to addiction and HIV, law enforcement and social-service authorities never coordinated ways to provide this information. "Drugs are easily accessible and rather cheap," Burhanov says.

The MRT program remains limited in its scope, but early results provide encouraging signs. The initial control group of 50 people in Osh included 42 men and eight women, with an average age of 34. Among them were 17 HIV-positive patients and 12 with tuberculosis. Slightly more than half of them were employed, while the rest were looking for work. They saw a range of specialists and underwent psychotherapy and family counseling. After medical examinations, 84 percent of them showed improved stability in outlook, weight and appetite. One client successfully began and carried out a pregnancy.

These results, says Burhanov, helped the project win "support from society" and "prove its social and medical importance." Now, Burhanov is calling on police and social-service agencies to help the project move beyond Osh. "One of the most important objectives of the project is to render assistance to healthy people who are at risk of infection, not only with AIDS but also hepatitis, TB and any other infectious disease."

At present, a second group of 50 patients has started treatment in Osh and another 50 are in a similar program in Bishkek. Doctors have reportedly discussed increasing the methadone program's patient base to 1,500.

For those who undergo MRT treatment, staying clean remains a challenge, some patients report. Alexander B., who has used methadone for more than one year, said methadone users are often approached by drug dealers outside of treatment centers. Many methadone users lack the will power to resist the repeated offers of drugs, Alexander added. "Dealers sell heroin openly. Each of them has 'protection' in law enforcement authorities," he said. "A decrease in drug addicts' numbers would not be profitable for them [dealers]."

The MRT program's preliminary success may have fed interest in a needle exchange program that began in 2000. A group called "Parents Against Drugs" helped start the program, targeting 200 intravenous drug users in Osh, according to consultant Rano Burhanova. Today it has served 500 people, Burhanova says, The project's growth, though, illustrates the sensitivities that state agencies will probably encounter if they broaden support for harm reduction.

"Users initially were afraid to come to us," Burhanova says, despite the program's policy of anonymity. "There was full ignorance. They were coming to us with awful abscesses and did not know that they could be infected with AIDS through syringes and then infect others. We gave them information through volunteers, consultations, booklets. Many called [a confidential phone line] and asked so many questions!"

Social workers deliver clean needles to most people who sign up for the program, since many users fear that authorities will tail them if they bring used syringes to the centers. Each field worker serves a circle of clients, who can call the worker at any time. Workers collect used syringes and disinfect them. According to Burhanova, the project has undergone some refinement.

"Before we gave everybody several syringes for each dose," says Burhanova. "Later, we started to train them to disinfect their syringe in order to use it several times. We also distribute condoms and train how to use them. Now our clients know which places they shouldn't use for injection."

Project participants say a lack of sympathy from police officers poses a major obstacle to the program's effectiveness. Officers have reportedly arrested field workers distributing clean needles, even interrogating them, in order to find drug addicts.

"One can understand the policemen as well. It is their work," said a social worker in the needle-exchange corps. "Many addicts not only use but also distribute drugs. But just when we start to earn the trust of our clients, the authorities want us to surrender them." Even if high-ranking officials understand the importance of harm reduction, workers say, it is very hard to communicate this principle to police in the field. And Kyrgyzstan's desire to register HIV-positive people may discourage people who need treatment from seeking it.